Provider Demographics
NPI:1497853386
Name:TAYLOR, DEBRA K (NP)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:K
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:K
Other - Last Name:HATFIELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6626 E 75TH ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2805
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:333 E COUNTY LINE RD
Practice Address - Street 2:SUITE B
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143
Practice Address - Country:US
Practice Address - Phone:317-497-6333
Practice Address - Fax:317-497-6334
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71001648A363LW0102X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200864210Medicaid
IN000000651250OtherANTHEM
INP01211434OtherRR MEDICARE PTAN
IN000000651250OtherANTHEM
IN200864210Medicaid
INM400029892Medicare PIN